1205280690 NPI number — DR. NIURKA JOHANNIE VISCONTI DO

Table of content: DR. NIURKA JOHANNIE VISCONTI DO (NPI 1205280690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205280690 NPI number — DR. NIURKA JOHANNIE VISCONTI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISCONTI
Provider First Name:
NIURKA
Provider Middle Name:
JOHANNIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATOS
Provider Other First Name:
NIURKA
Provider Other Middle Name:
JOHANNIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205280690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CORPORATE DR UNIT B104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-6346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-769-9133
Provider Business Mailing Address Fax Number:
860-321-4553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CORPORATE DR UNIT B104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-6346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-769-9133
Provider Business Practice Location Address Fax Number:
860-321-4553
Provider Enumeration Date:
04/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  63608 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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